Tracheostomy Decannulation: Suprastomal Granulation Tissue in Perspective

Background: Suprastomal granulation tissue is a complication of tracheostomy which may make decannulation difficult and presents a therapeutic challenge to the Otorhinolaryngologists. The aims of this study therefore were to evaluate tracheostomy in black African population, determine the prevalence of suprastomal granulation tissue and provide updated information on it that will enable the otorhinolaryngologists to better understand and manage the lesion.Methods: We reviewed case files of patients who had tracheostomy between 1993 and 2007 at University College Hospital, Ibadan, Nigeria for essential clinical data.Results: Of the 256 patients who had tracheostomy, 133(51.95%) had prior orotracheal intubation for 10 – 21days. Suprastomal granulation tissue complicated 16 (6.25%) cases, this accounted for 88.89% of cases of failed decannulation. Indications for tracheostomy in these patients included severe head injury in 12 (75%), tetanus in 3 (18.75%)] and intubation granuloma in 1(6.25%) of these cases. Sixteen (4.3%) cases had stomal infection.Conclusion: This study showed that the prevalence of suprastomal granulation is high among our patients. There is a need for good surgical tracheostomy technique to prevent this complication and stomal infection should be promptly treated while cuffed orotracheal intubation for more than two weeks in unconscious and tetanus patients should be avoided

Etiological Profile and Treatment Outcome of Epistaxis at a Tertiary Care Hospital in Northwestern Tanzania: A Prospective Review of 104 Cases.

Epistaxis is the commonest otolaryngological emergency affecting up to 60% of the population in their lifetime, with 6% requiring medical attention. There is paucity of published data regarding the management of epistaxis in Tanzania, especially the study area. This study was conducted to describe the etiological profile and treatment outcome of epistaxis at Bugando Medical Centre, a tertiary care hospital in Northwestern Tanzania. This was a prospective descriptive study of the cases of epistaxis managed at Bugando Medical Centre from January 2008 to December 2010. Data collected were analyzed using SPSS computer software version 15. A total of 104 patients with epistaxis were studied. Males were affected twice more than the females (2.7:1). Their mean age was 32.24 ± 12.54 years (range 4 to 82 years). The modal age group was 31-40 years. The commonest cause of epistaxis was trauma (30.8%) followed by idiopathic (26.9%) and hypertension (17.3%). Anterior nasal bleeding was noted in majority of the patients (88.7%). Non surgical measures such as observation alone (40.4%) and anterior nasal packing (38.5%) were the main intervention methods in 98.1% of cases. Surgical measures mainly intranasal tumor resection was carried out in 1.9% of cases. Arterial ligation and endovascular embolization were not performed. Complication rate was 3.8%. The overall mean of hospital stay was 7.2 ± 1.6 days (range 1 to 24 days). Five patients died giving a mortality rate of 4.8%. Trauma resulting from road traffic crush (RTC) remains the most common etiological factor for epistaxis in our setting. Most cases were successfully managed with conservative (non-surgical) treatment alone and surgical intervention with its potential complications may not be necessary in most cases and should be the last resort. Reducing the incidence of trauma from RTC will reduce the incidence of emergency epistaxis in our centre

Noise-Induced Hearing Loss in Laundry Workers in Lagos

The noise levels and the effects of occupational noise exposure were determined in the students' hostels, administrative offices and the laundry department of Lagos University Teaching Hospital (LUTH). All 40 test subjects and 54 control had comprehensive otological screening and fulfilled other inclusion criteria. The subjects had pure tone audiometric assessments by means of a standard calibrated diagnostic audiometer. Noise levels determined using a standard sound level meter averaged 45dB(A) in the administrative offices and students' hostels and 100.5dB(A) in the laundry department. The prevalence of noise-induced hearing loss, NIHL, among the control group was 9.3% and 65% in the laundry department. The results show a significant threshold shift at all test frequencies in the laundry workers compared with control. When considered by duration of exposure, laundry workers showed significant NIHL in the first decade of exposure (Pure Tone Average, PTA, 29.7), that did not seem to worsen in the second decade of exposure (PTA 26.4) only to show a more severe loss in the third decade (PTA 30.6). None of the laundry workers used hearing protective devices although the establishment provided these for them. Considering the fact that NIHL is preventable but irreversible once it is established, there is need for employee education concerning the continuing use of protective hearing devices. We also suggest pre-employment and regular on-the-job audiometric assessments to enable appropriate placement of workers susceptible to noise. Where possible, actual reduction of industrial noise by use of silencers or modification of the machines used should be encouraged. These measures will protect the general health of the employees while also reducing the economic loss suffered by employers as a result of NIHL and general ill health. Key Words: Noise, Hearing Loss, Protective Device, Laundry Nigerian Medical Practitioner Vol.44(1) 2003: 3-

Otorhinolaryngology and Geriatrics in Ibadan, Nigeria

Background: Changing demographics trends in our country will have a profound influence on the future practice of otolaryngology. The geriatrics population has already become the fastest-growing segment of our society and it will continue to be so for decades to come and very soon a larger percentage of patients treated by Otolaryngologist will be in the over 65 age groups. The aim of this study is to present our observations on geriatrics ORL as seen in Ibadan, Nigeria. Methodology: A retrospective study analysis of 170 geriatrics patients that presented in the Ear, Nose and Throat Department of the University College Hospital, Ibadan, Nigeria between 2000 and 2004 was done. The diagnosis in each subject was based on history, clinical findings, and investigations done on each subject at the time of presentation. Results: 170 geriatrics patients were seen and treated over the 5-year studied period with 94 males (55.3%), 76 females (44.7%) (M:F 1.2:1) and with an average age of 70.9 years (age range 65-97 years). The geriatrics patients constituted 3.64% of the total new cases (4,675) seen during the studied period. Majority of the patients lived in the towns and cities 109 (64.1%) while 61 (35.9%) lived in the villages. 158 (92.9%) were married with 69 (40.6%) engaged in trading as an occupation while 54 (31.8%) and 23 (13.5%) were pensioners and housewife respectively. Only 16 (9.4%) still engaged in farming activities. The main presentations in these geriatrics patients were otological presentations 114 (67.1%) followed by rhinological 31(18.2%) and laryngeal presentations 22 (12.9%) respectively. Facio-plastic presentations were of 3 (1.8%) cases. Presbycusis 35 (30.7%) and cerumen auris 30 (26.3%) were the main otological problems encountered. Rhino-sinusitis 20 (58.8%) constituted the main rhinological problems seen. Laryngeal carcinoma 10 (41.7%) and pharyngo-laryngitis 6 (25%) constituted the main laryngeal problems found in this study. Majority of the patients were treated as outpatients 160 (94.1%), only 10 (5.9%) required admission for their treatments with an average hospital stays of 3-weeks. Conclusion: In conclusion, presbycusis, cerumen auris, rhino-sinusitis, and laryngeal carcinoma were the main otorhinolaryngological presentations seen among the geriatrics studied. With the explosive growth of the elderly population, this group will become a larger percentage of patients in the future and Otolaryngologist would need to be prepared to take care of these categories of patients adequately. Current and newly developed information relating to geriatrics in otolaryngology must be incorporated into present training of Otolaryngologist. Continuing education programs in geriatrics otolaryngology should be provided for all physicians in family practice to ensure early referral of such cases to ORL specialists. Key words: geriatrics, otolaryngology, presbycusis, sinusitis, laryngeal carcinoma. Nigerian Journal of Otorhinolaryngology Vol.2(1) 2005: 7-1

Nasal septal abscess in Ibadan, Nigeria

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Traumatic tympanic membrane perforations: an overview in tertiary care hospital

Abstract This hospital-based prospective study was conducted in the Department of Ear Nose Throat, Head and Neck Surgery, Government Medical College Srinagar, Jammu and Kashmir, for a period of 1 year from June 2013 to June 2014 with the aim of studying the aetiological factors, clinical presentation and management options for traumatic tympanic membrane perforations. A total of 50 patients with traumatic perforations of the tympanic membrane were enrolled in the study, comprising of 34 males and 16 females patients. Age of the patients ranged from 12 to 56 years, with a mean age of 32 years. The results showed that the most common mode of trauma was slaps (56%); sudden hearing loss and tinnitus were the two most common presentations (92%). Audiometry shows that the larger the tympanic membrane perforation, the larger the air–bone gap. Hearing loss was highest at the lowest frequencies and generally decreased as the frequency increased. The differences in air–bone gaps between small and large perforations were significant at all frequencies (P<0.05, Student’s t-test). Overall, 72% of patients responded to conservative management, whereas 28% needed fat myringoplasty and/or chemical cauterization